Central Serous Chorioretinopathy (CSC or CSR – short for Central Serous Retinopathy) occurs in young adults who complain of central blurring of vision. At the early stage, there is a small area of leakage of fluid (or water bubble) underneath the retina at the macula region. In late stages, there can be large amounts of fluid beneath the retina that may damage the retina and lead to vision loss that cannot be reversed.
Central Serous Chorioretinopathy is more common in men than in women, although the exact reasons for this are unknown. Though it can occur in adults of all ages, young and middle-aged adults form the largest age group for Central Serous Chorioretinopathy patients.
The most commonly reported symptom of Central Serous Chorioretinopathy (CSC) is blurred vision or reduced visual acuity, typically affecting one eye. However, upon detailed examination by an eye specialist, mild visual disturbances may also be detected in the other eye. In cases where the serous fluid pocket is located within the macula, patients may also experience central vision loss.
In the early stages, vision loss caused by CSC is often reversible, as the fluid accumulation can resolve on its own. However, in later stages, prolonged or recurrent fluid leakage may lead to irreversible damage to the retina. If significant retinal damage has occurred, the central vision loss may become permanent, depending on the extent of structural deterioration.
The severity of symptoms in Central Serous Chorioretinopathy (CSC) depends largely on the location of fluid accumulation within the eye, particularly beneath the retina. If the serous detachment occurs at the periphery or outside the macula, symptoms may be minimal or even unnoticeable to the patient. This is because the macula is responsible for processing fine details, such as those required for reading or distinguishing between similar objects.
When fluid leakage and detachment occur outside the macula, they may go undetected for a prolonged period. Over time, this can lead to significant damage to critical structures such as the retinal pigment epithelium (RPE). Damage to the RPE can result in photoreceptor atrophy, potentially causing long-term vision impairment even if the condition initially appeared asymptomatic.
Causes of Central Serous Retinopathy are not clearly understood, although there are certain risk factors identified that contribute to the likelihood of developing this condition.
Risk factors for CSR are:
It is believed that usage of corticosteroid medication may also possibly lead to developing or worsening Central Serous Chorioretinopathy. These steroids are commonly found in nose sprays used for managing allergy symptoms and anti-inflammatory external use creams for skin. These drugs, depending on the region you live in, can be readily available over-the-counter. In Singapore, there are a number of over-the-counter products that can be purchased without a prescription from a medical practitioner.
A link has been found between Central Serous Retinopathy and persons with a “Type A” personality and/or persons undergoing emotional and physical stress as a risk factor. It is believed that the body possibly produces substances that act like corticosteroids during times of stress, and may contribute or set off the development of Central Serous Chorioretinopathy in a person that is already susceptible or prone to it.
When investigated, roughly about half the patients suffering from Central Serous Chorioretinopathy have at least one relative with traces of this condition upon examination. This leads us to believe that genes may play a role in the susceptibility of a person to this condition. However no specific inheritance patterns have been found or identified thus far.
These tests will allow the eye specialist to fully distinguish between Central Serous Chorioretinopathy and all the other possible conditions that may cause fluid to collect in the eye, or at the retina.
The first and probably most important test is a complete and detailed eye examination of both the eyes by an eye specialist. The eyes will be dilated during this examination, and if required, images will be captured to document the existence and current condition of the patient.
Other tests such as an OCT – short for Optical Coherence Tomography, which allows the eye specialist to study the retina at a microscopic level, are useful for diagnosis. This allows the eye specialists to identify minute pockets of leaked fluid or areas where it has happened before.
Fluorescein angiography can also be used to obtain detailed images of both eyes. This procedure involves injecting a specialized dye into the patient’s bloodstream, which allows the eye specialist to identify areas of fluid accumulation. As the dye circulates, it highlights pockets of fluid where it collects, helping to pinpoint the exact location of leakage and assess the extent of leakage.
In the past, it was thought that CSR could resolve on its own within 6 months so treatment was delayed while waiting for self-resolution. We know now that treatment is best done early before any inadvertent retinal damage ensues. Treatment options include medication and different types of laser depending on the severity.
Patients that have been diagnosed will be advised to stop usage of any steroids. In the case that you are required to as part of another prescription, or are unsure of the nature of the product, feel free to consult your eye specialist and the prescribing medical practitioner on what can be done in this situation. Sudden discontinuation of steroids at high doses can be dangerous, always seek medical advice on the proper course of action when it comes to steroids.
Photodynamic therapy (PDT) is one of the laser treatment options available. A photosensitive drug is administered via a vein injection, and then activated by using a special cold laser at the areas affected by Central Serous Chorioretinopathy. This treatment is effective in stopping the leakage of fluids at the sites in the retina/macula.
At Asia Retina, we recognise that every case of Central Serous Chorioretinopathy can be similar in many ways. yet different for each individual. Still, early detection of Central Serous Chorioretinopathy is very helpful in preventing further vision loss and aiding in risk factor management. Permanent vision loss can also be avoided when Central Serous Chorioretinopathy is detected early enough.
We are able to provide non-damaging laser treatment in the early stage of CSR to avoid permanent vision loss and achieve better visual outcomes for our patients.
